Ethics Forum: Facebook Friend Request from Patient Raises Concern for Rheumatologist

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Social media has revolutionized my practice. I stay current with Twitter content from other rheumatologists, patient organizations and medical journals. I am also an active member of the international Twitter-based rheumatology journal club, #RheumJC. Still, I was recently surprised when my patient’s name appeared in a friend request.

This same patient was following me on Twitter, where I had no say in the matter, but this did not affect me. (There is an option to restrict your followers, but those sorts of restrictions would defeat the purpose of my account, because I was [and still am] trying to share my knowledge and findings on Twitter rather than restrict them.) I was pleased that my patient wanted to become more involved with his care and that following me on Twitter meant that he was following a reputable source of information. However, when the friend request popped up on Facebook, I felt uneasy and uncertain about what to do next. I also wondered if there were any accepted standards for interacting with patients using social media.

Discussion

The practice of consulting the Internet on health matters is ubiquitous. Eighty percent of those on the Web are seeking healthcare information, and more than one-third of U.S. caregivers participate in online social activities.^1,2 Social media has become an efficient tool to disseminate medical information, to promote patient safety and health literacy, and to engage patients and providers in health advocacy. Younger trainees are now learning with the power of one thumb, and patient outcome research is now using social media with increasingly positive results. Medicine is changing, and social media is reshaping the patient–physician relationship as we know it.³

There is no clear, accepted standard on how to use social media in a patient–physician relationship. The Sixth Edition of the American College of Physicians Ethics Manual warns physicians who use online media about the potential to blur social and professional boundaries and recommends that physicians record any patient–physician interactions.⁴ Additionally, the mere existence of an online patient–physician relationship could, in some cases, represent a violation of the Health Insurance Portability and Accountability Act of 1996.

How can we ensure the security and privacy of messages sent to and from patients? How can physicians ensure that patients are conscientious about the issue of privacy? Although patients’ information belongs to them, physicians who engage in social media may have a role in educating patients to ensure they know that a message they think is personal may be seen by the whole network of the person to whom it was directed, depending on the privacy settings and policies of the social media platform.